Healthcare Provider Details

I. General information

NPI: 1770610446
Provider Name (Legal Business Name): WENDY N CARPENTER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WESTFALL RD
ROCHESTER NY
14620-4610
US

IV. Provider business mailing address

82 RIO GRANDE DR
NORTH CHILI NY
14514-9780
US

V. Phone/Fax

Practice location:
  • Phone: 585-461-8743
  • Fax: 585-461-8545
Mailing address:
  • Phone: 585-241-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number016393-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: